Dispelling An Urban Legend: Frequent Emergency Department Users Have Substantial Burden Of Disease

In this new health care environment, there is a lot of discussion about frequent Emergency Department (ED) visits and reducing hospital readmissions. A recent study published in Health Affairs presents some findings that are counter-intuitive.  Though the findings are drawn from only one state’s Medicaid system, it is important to consider these results alongside studies in other states and the nation.

Frequent ED users are often assumed to be persons with co-occurring behavioral health conditions such as mental illness and substance abuse. And that may still be true in many cases. However, a recent Health Affairs article, Dispelling An Urban Legend: Frequent Emergency Department Users Have Substantial Burden Of Disease, finds that these “behavioral health conditions are responsible for a small share of ED visits by frequent ED users, and that ED use accounts for a small portion of these patientstotal Medicaid costs.”

Based on the multi-year New York City Medicaid data used in the study, frequent ED users are responsible for a fairly large share of all ED visits by Medicaid recipients. However, ED use accounts for a small share these patients’ total Medicaid costs. This would suggest that the frequent ED users are utilizing other health care services.  In fact, the study found that the frequent ED users did have fairly strong linkages to primary and specialty care outside the hospital.

Not surprisingly, the study finds that frequent ED users are quite sick and have a high prevalence of chronic disease.  The repeat ED users examined in this study did have a high prevalence of substance use and mental illness.  However, these users visited the ED for reasons other than substance use and mental illness; in fact visits due to these conditions represented a fairly small portion of their ED visits overall.

Based on these findings of high chronic disease prevalence and linkages to primary care, there is an opportunity to improve treatment of these patients in the primary care setting. The study authors suggest interventions that focus on increased care management and coordination may result in better health outcomes and reduced costs.

This study is important for behavioral health and primary care providers, particularly those who take Medicaid and also treat patients with chronic disease. Community behavioral health providers and primary care providers should consider whether these results also exist with their patient population.  If so, these results will be important tools to use in when working with policy makers, stakeholders, community partners, and funders.

To read the Health Affairs article, click here.

Map Tutorial on Virginia Atlas of Community Health

cropped-title_logo1 VA Health Atlas2This quick video provides a tutorial on producing a map of the uninsured using the Virginia Atlas of Community Health. Bear in mind we are making some enhancements to the Atlas and we will be posting new videos as we roll out the changes.


Also please take a few minutes to complete our Atlas Enhancement Survey here: https://www.surveymonkey.com/s/AtlasEnhancement

More Americans Successfully Managing Diabetes

Shared by Sally Graham,Goochland Free Clinic and Family Services:  Interesting article in US News and Reports discussing a diabetes control study reported in DIabetes, Feb. 15th. The study examined the percentage of people with HgbA1C’s < 7 but also the percentage with good blood pressure and cholesterol control. In addition, the article addresses health care disparities found in the study. The “ABC’s” approach to evaluating control was a helpful reminder to address “A”- A1C, “B”- blood pressure, and “C”- cholesterol when treating patients with diabetes.


How Medicaid Works: A Chartbook for Understanding Virginia’s Medicaid Insurance and the Opportunity to Improve It

The Commonwealth Institute has recently published “How Medicaid Works: A Chartbook for Understanding Virginia’s Medicaid Insurance and the Opportunity to Improve It.” This chartbook provides a concise summary of the cost and benefits of Medicaid expansion in Virginia.  It can be viewed online at:


On-line Preventive Care Resource Site

Shared by Sally Graham,Goochland Free Clinic and Family Services:  The Guide to Community Preventive Services is a free resource to help you choose programs and policies to improve health and prevent disease in your community. Systematic reviews are used to answer these questions:

  • Which program and policy interventions have been proven effective?
  • Are there effective interventions that are right for my community?
  • What might effective interventions cost; what is the likely return on investment?


About Half the States are Implementing Patient-Centered Medical Homes for their Medicaid Population

Half of state Medicaid programs are taking new approaches to provider payment—focusing on chronically ill populations, using shared teams, aligning payments with national quality standards, and implementing shared-savings programs—to help primary care practices become patient-centered medical homes for their low-income patients.

  • 19 of the 25 states that have implemented payment changes are paying providers a permember per-month care management fee to perform the functions of a PCMH.
  • Minnesota designed a care management fee that was adjusted according to the number of a patient’s chronic conditions.
  • Many states are asking practices to link payments with meeting standards of care, like those set by the National Committee for Quality Assurance (NCQA).

As you continue to work on PCMH development at your organization, consider these innovative payment reforms occurring around the country. Not only is the work you are doing improving patient care, but also innovations such as these are attempting to align payment with the higher quality of care delivered.